The investigator Tasuku Honjo He doesn't know how many people owe him his life. Maybe hundreds of thousands? "Possibly," he replies. Honjo, born in the Japanese city of Kyoto 77 years ago, won the 2018 Nobel Prize for Medicine for discovering a revolutionary cancer treatment: immunotherapy. One of the first successful cases is recorded in his mind, that of a 60 year old woman with ovarian cancer After one year of treatment, it was clean.
Honjo identified in 1992 a protein, PD-1, which acts as a brake on the body's defenses. By releasing these reins, through a medicine called nivolumab, the immune system attacks the tumor cells with viciousness. The strategy –effective for about 25% of patients– It has been approved since 2014 for some types of skin, lung, kidney and liver cancer. And the indications do not stop growing. There are 2,000 clinical trials underway. Nivolumab sales exceed 4,300 million euros annual
The Japanese scientist, passing through Madrid to receive an award from the Fernández-Cruz Foundation, feels cheated. In 2003, Honjo patented its first results with the Japanese pharmaceutical company Ono Pharmaceutical, a company that ended up signing an agreement with the American giant Bristol-Myers Squibb to manufacture the nivolumab, under the trade name of Opdivo. A treatment for a person can cost between 50,000 and 100,000 euros a year, depending on the country. Honjo, from the University of Kyoto, receives less than 1% in copyright. He wants more, he says, to donate.
Question. You are optimistic. Do you think a day will come when nobody will die of cancer?
Reply. I think cancer can be a chronic disease someday. You cannot say that no one will die of cancer, because even today there are still people dying from infectious diseases, but I believe that cancer will not threaten our lives.
"You can't say that nobody will die of cancer, but I don't think it will threaten our lives."
P. In the Nobel conference You said cancer could be a chronic disease in 2050.
R. It's a hope, I have no guarantees, of course.
P. What do you think of the price of the Opdivo [the pioneer immunotherapy drug, developed thanks to the discoveries of Tasuku Honjo]? In some countries it exceeds 50,000 euros per patient.
R. Scientists do not participate in determining the price of medicines. It depends on each country, on its welfare state model, so I cannot comment. Of course, it would be better if it were cheaper, so that everyone could benefit. The problem always occurs with any drug. Even penicillin, when it hit the market, was very expensive. And then it was affordable for anyone.
P. You has publicly denounced which receives less than 1% from the company Ono Pharmaceutical for patent rights by the Opdivo. Have you gone to court?
R. Our lawyers are negotiating.
P. Less than 1%, being the father of the original idea, is nothing.
"The academic field is the stupidest group when it comes to managing patent issues"
P. What do you think of this patent system?
R. The academic field is the stupidest group when it comes to managing these issues. Under normal conditions, the process should not have been like that. We expected the company to be honest and sincere, but that has not been the case. The lawyers are negotiating and, if they do not reach an agreement, I think we will have no choice but to go to court.
P. What figure would you consider fair? 5%? 6%
R. 5% is a usual percentage that everyone accepts. If it were 5%, I wouldn't put many problems.
P. It is estimated that the sales of the Opdivo can exceed 10,000 million euros annually. 5% would be a lot of money. What do you want to do with those hundreds of millions of euros?
R. My plan is to put this money in a fund from the University of Kyoto dedicated to supporting young researchers.
"Even penicillin, when it hit the market, was very expensive. And then it was affordable for anyone."
P. In the case of the Opdivo, as usual, the results of an investigation with public money, from the University of Kyoto, have ended up in the hands of a private company. Are other systems possible? Can you imagine a great public pharmacist?
R. A pharmaceutical industry operated by the government? Public management is a disaster, normally. Think of the rail system or the postal system, both very inefficient. They cannot compete with the private sector. As for pharmaceutical companies, I think it is better to have private companies, but they must be very open and sincere. They have a responsibility to support people's health care. And, of course, governments must have specialized regulations to strengthen the welfare state.
P. Only between 20% and 30% of patients respond to immunotherapy. What happens to others?
R. There are two possibilities. The first is that the tumor is not well identified by the immune system. The reason why the immune system recognizes a tumor is because cancer changes with mutations in its DNA, but leukemia, for example, does not have many mutations. And leukemia does not respond to immunotherapy. The second factor is that each individual has a different immune response capacity. For example, when you catch the flu you may have a headache and sneeze, but other people end up even in the hospital. We are trying to improve the response to immunotherapy with a combination of anti-PD-1 drugs and other chemicals.
P. Have you ever calculated how many people saved your life?
R. I don't have the data, I don't know.
P. But maybe we are talking about hundreds of thousands of people.